de l'Escalopier Nicolas, Barbier Olivier, Demoures Thomas, Ollat Didier, Versier Gilbert
Orthopedic Department, Begin Military Teaching Hospital, 69 Avenue de Paris, 94160 Saint-Mandé, France.
Mil Med. 2018 Jan 1;183(1-2):e134-e137. doi: 10.1093/milmed/usx040.
Stabilizing surgery of the shoulder with a coracoid graft according to Latarjet is a recognized surgical treatment for anterior instability of the shoulder. This pathology frequently affects soldiers. Postoperatively, the potential risk of recurrence or of secondary shoulder arthritis can limit the practitioner in their ability assessment. The aim of this study is to analyze the long-term outcomes of this surgery in a military population, in order to assess the possible implications for French soldiers' medical ability.
Twenty soldiers operated on the shoulder by Latarjet procedure by the same surgeon were retrospectively reviewed after more than 15 yr. All of them did regular physical activity for leisure or competitions. None had preoperative osteoarthritis injuries. The number of dislocation recurrences, the functional score, and the rate of radiographic osteoarthritis were assessed.
After more than 16.3 yr (extremes: 15-24 yr), none displayed a dislocation recurrence. The average Rowe's score was 91.8 ± 9.9. The average subjective shoulder value was 89.2 ± 9.7. All patients had resumed sport. Three of them developed level 1 or 2 radiological signs of osteoarthritis according to Samilson. No level 3 or 4 osteoarthritis was found. Among all the patients, 14 still did regular physical activity.
In view of our results and of those from the literature, the results of treatment for anterior shoulder instability with the Latarjet procedure are good, even very good in the long term. These data must be considered to favor this procedure for soldiers with shoulder instability and from a medico-administrative viewpoint for military patients in order to pursue their careers without any job restrictions.
根据拉塔热（Latarjet）术式采用喙突移植进行肩部稳定手术是治疗肩部前向不稳的一种公认的外科治疗方法。这种病理情况经常影响士兵。术后，复发或继发性肩关节关节炎的潜在风险可能会限制从业者对其能力的评估。本研究的目的是分析该手术在军人中的长期疗效，以评估对法国士兵医疗能力的可能影响。
对同一位外科医生采用拉塔热手术治疗肩部的20名士兵进行了回顾性研究，随访时间超过15年。他们都有规律地进行休闲或竞赛类体育活动。术前均无骨关节炎损伤。评估脱位复发次数、功能评分和影像学骨关节炎发生率。
在超过16.3年（范围：15 - 24年）的随访后，无一例出现脱位复发。平均罗（Rowe）氏评分为91.8±9.9。平均主观肩关节评分为89.2±9.7。所有患者均恢复了运动。根据萨米尔森（Samilson）标准，其中3例出现了1级或2级骨关节炎的影像学表现。未发现3级或4级骨关节炎。所有患者中，14人仍有规律地进行体育活动。
鉴于我们的结果以及文献中的结果，采用拉塔热手术治疗肩部前向不稳的效果良好，从长期来看甚至非常好。从医疗管理角度出发，对于有肩部不稳的士兵以及军事患者而言，为了他们能不受任何工作限制地继续职业生涯，这些数据支持采用该手术方法。
